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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000752

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Michael JohnMansour Sex Male

Date of Birth June 22, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Joseph J. Mansour MAIDEN NAME of Mother Lucy Baxter

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Halifax Present address of Father deceased

Occupation of Father at Birth of child Grocer Place of birth of Father Lebanon

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael Mansour Address of Applicant Halifax Date January 7, 1976

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Michael JohnMansour

Born at Halifax in the County of Halifax

That Michael JohnMansour Whose Birth is sought to be registered was

born at Halifax Halifax County on June 22, 1920

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Baptismal

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